WHO Philippines Response to Typhoon Haiyan

(Yolanda): the first six months

May 2014

List of Acronyms
DOH
EINC
ERF
ESR
IEC
MDR
mhGAP
MHPSS
NBI
NCR
NDRRMC
NGO
OCHA
ORI
PIDSR
RDT
SOP
SPEED
STOP
TB
UN
UNICEF
UNRC
WASH
WHO

Philippine Department of Health

Essential Intrapartum and Newborn Care
Emergency Response Framework
Event-based Surveillance and Response
Information, Education and Communication
multi-drug resistant
Mental Health Global Action Program
Mental Health and Psychosocial Support
National Bureau of Investigations
National Capital Region
National Disaster Risk Reduction and Management Council
Non-governmental Organization
Office for the Coordination of Humanitarian Affairs
Outbreak Response Immunization
Philippine Integrated Disease Surveillance and Response System
Rapid Diagnostic Tests
Standard Operating Procedures
Surveillance in Post Extreme Emergencies and Disasters
Stop Transmission of Polio
Tuberculosis
United Nations
United Nations Childrens Fund
UN Resident Coordinator
Water, Sanitation and Hygiene
World Health Organization

Summary
Super typhoon Haiyan (locally known as Yolanda) struck the Philippines on 8 November 2013. With
maximum winds of 230 km/hour reaching 315 km/hour at some points, it had devastating effects, causing
destruction across the Central Philippines. According to the Philippine National Disaster Risk Reduction
and Management Council, at the peak of the event 4.4 million people were displaced and 1 551
evacuation centres were housing 398 377 people.
In response to Typhoon Haiyan, the World Health Organization (WHO) received aid from a number of
donors to provide essential and emergency healthcare to the affected populations. Contributions were
received from the Governments of Australia, Canada, Japan, Kuwait, Monaco, Norway, the Republic of
Korea, the Russian Federation and the United Kingdom. Funding was also received from the Central
Emergency Response Fund of the United Nations and from the Japan Private Kindergarten Association
along with staff from the WHO Non-governmental Organization Consortium and members of the Global
Outbreak Alert and Response Network.
With the help of these donors WHO has been able to:

Meet the immediate healthcare needs of the people in the affected areas, especially for obstetric
and neo-natal care, trauma care, mental health and psychosocial support, chronic conditions and
infectious diseases.
Strengthen the alert and surveillance capability in order to contain potential disease outbreaks.

All these activities have been in support of the Philippine Department of Health (DOH) and tailored to
strengthen local capacity. All necessary steps have been taken to avoid duplication of services and ensure
equitable access for all beneficiaries to services across the implementation area. Care has been taken to
coordinate and integrate health care with other services and clusters on issues such as protection and
gender.
As of April 11, 2014 it is reported by the Government of Philippines that there are:

Over 16 million affected

4.1 million displaced
28 689 injured
6283 dead
1061 missing

While emergency healthcare activities are on-going in the three most affected regions of the country, the
WHO has also begun the longer term rehabilitation of health services for the affected populations and to
strengthen provision in priority areas such as psychosocial support.
WHOs Immediate Response to Typhoon Haiyan
WHO Philippines worked to prepare for a rapid response before Typhoon Haiyan struck. On 6 November
2013, the WHO Representative, as acting UN Resident Coordinator, attended the National Disaster Risk
Reduction and Management Council (NDRRMC) meeting alongside the heads of all key operational
agencies of the government, UN agencies and humanitarian agencies active in the Philippines. The
meeting reviewed the preparations for Typhoon Haiyan and the roles of the participating agencies. The
WHO Representative, as acting UN Resident Coordinator, sent a letter to the Secretary of National
Defense offering UN support in preparedness efforts. The WHO Representative also formally offered
WHOs full support to the DOH for the Governments preparedness efforts.

WHO worked with DOH to ensure there was a rapid assessment of response capacities within the country,
including assessment of vaccine status, health facilities and public health risks. WHO ensured the prepositioning of existing stock and ordered urgent supplies from local and international sources.
Within 72 hours of the typhoon striking, the first Health Cluster coordination meeting was held, chaired
by the WHO Representative. The Government of the Philippines declared a national state of calamity on
11th November 2013, in the provinces of Samar, Leyte, Cebu, Iloilo, Capiz, Aklan and Palawan. Local
governments of the municipalities of Dumangas and Janiuay in Iloilo province, as well as the provinces of
Antique and Bacolod also announced a state of calamity.
In light of the scale and complexity of the emergency, WHO categorized the response to Typhoon Haiyan
as a Grade 3, the highest internal emergency category and mobilized organization-wide support for the
country. Emergency operation centres across the three levels of the organization were activated. The
WHO Philippines country office established its Emergency Management Team, while Emergency Support
Teams were organized in the Western Pacific Regional Office and at WHO Headquarters.
Following WHOs Emergency Response Framework (ERF) procedures, and to fulfil WHOs core functions in
emergencies, staff from the Western Pacific Regional Office, Headquarters and other regional offices were
repurposed and deployed to support the Philippines Country Office in the response. External health
experts in various fields were also deployed. The Global Health Cluster and the Global Outbreak Alert and
Response Network were activated to mobilize expertise. Experts and staff joined the WHO team from
around the world, including from many of the donor countries who also provided funds directly to WHO.
WHO worked with the DOH as co-lead of Health Cluster in responding to the health needs of the affected
communities.
As co-lead for the Health Cluster, WHO provided
immediate coordination support to the DOH and
Health Cluster partners. The support of the WHO
included coordination of field hospitals, over 500
tonnes of medical supplies and over 150 foreign
medical teams to help restore the capacity of the
affected regions health system to provide basic
emergency services to the affected populations.
WHO also worked to ensure there was a multisectoral approach including close cooperation
with the Water, Sanitation and Hygiene (WASH),
Nutrition, Food Security and Agriculture,
Emergency Shelter, Protection and Logistics
Clusters to tackle the main causes of morbidity
and mortality.
Since the typhoon struck, WHO-led health
recovery operations have been focused in the
following four thematic areas as set out in the Strategic Response Plan:
1. TREAT: Address the immediate health needs of the affected especially for obstetric and neonatal
care, mental health and psychosocial support, and the care of the deceased and bereaved.
2. PREVENT: Strengthen the alert and surveillance capability to address public health threats and
inform the provision of health care including immunization and outbreak response.
3. REBUILD: Establish an equitable basic system of primary and secondary healthcare functions, and
access to a tertiary referral system in all areas (including management of victims of gender based
violence) without financial barriers to access for affected populations.
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4. LINK: Strengthen the coordination and integration of health care with other services and clusters
including for protection issues around mental health and psychosocial support and gender based
violence.
The geographical areas of focus for WHOs work on the Typhoon Haiyan response as requested by DOH
are Region VI (all provinces), Region VII (provinces of Bohol and Cebu) and Region VIII (provinces of
Eastern Samar, Western Samar, Biliran and Leyte).
This report provides an initial overview of progress in each of the four thematic areas based on the best
information currently available.
Progress
1. TREAT: Address the immediate health needs of the affected, especially for obstetric and neonatal care,
mental health and psychosocial support, and care of the deceased and bereaved.
Within the first 72 hours of the typhoon, medicines, hygiene supplies and 1350 dignity kits along with
seven Rural Health Unit kits were pre-positioned for deployment. The procurement and dispatch of body
bags to the affected sites, starting with Tacloban, was organized. WASH supplies were pre-positioned in
regions IV-B, V, VI, VII, VIII and X. Three water treatment units arrived in Cebu for Tacloban and a water
treatment unit from Tagbilaran was delivered to Ormoc, Leyte province. A further 1000 jerry cans and 20
000 aquatabs for Region VIII were mobilized; 500 jerry cans and 10 000 aquatabs were mobilized for
Region VI.
As the response to Typhoon Haiyan has continued, WHO has used pre-positioned and additional supplies
to help ensure Rural Health Units are able to deliver basic health care packages. WHO has also trained
staff and helped support those who have themselves been affected by the typhoon to get back to work.
WHO coordinated 150 foreign medical teams, both to facilitate their work and to ensure an equitable
delivery of medical care and services across the affected population. Following a request from Office for
the Coordination of Humanitarian Affairs (OCHA) and humanitarian partners, WHO is currently taking part
in an interagency intervention in Biasong (San Isidro) to support a tent community that has no Barangay
Health Station.
WHO has taken special care to ensure that
the immediate healthcare needs of the
more vulnerable sections of the affected
population are adequately met. Outlined
below are some of the activities
undertaken by WHO to target these needs.
1.a Obstetric and Neonatal Care
In the immediate aftermath of the
typhoon, WHO and UNICEF promoted
breast feeding to mothers across the
affected region and provided policy and
advocacy support to mitigate against the
risks of the use of breast milk substitutes.
WHO distributed Essential Intrapartum and
Newborn Care (EINC)[1] materials to health
[1]

The search for EINC is the number one reason people currently visit the WHO Philippines website.
http://www.wpro.who.int/philippines/areas/maternal_child_nutrition/newborn_mother_care/en/

cluster partners. WHO and DOH had previously developed the standardised training for EINC (including nonbreathing baby training materials) that was rolled out across key Haiyan affected areas. The training was first
piloted and rolled out in Bohol, followed by two trainings for trainers in Ormoc City and a further one for Iloilo
province. The training was reported to have helped dramatically to improve the quality of care provided.
While coordinating the work of 150 foreign medical teams, WHO was focused on making sure that there
were sufficient reproductive health care facilities across the affected regions in the aftermath of the
typhoon. WHO encouraged all non-government organizations (NGOs) to follow DOH policies and protocols
for quality assurance on reproductive health care. WHO has continued to focus coordination on addressing
gaps in emergency obstetric, maternal and child care.
WHO has conducted and concluded a comprehensive stock-take of the available maternal and child health
services, facilities and human resources in Region VIII including undertaking GIS mapping to determine
accessibility of facilities. Among the affected population there are more than three million women of
reproductive age, about one million of whom are displaced. Six months after the typhoon struck, over
80 000 babies have been born in the affected areas. In the next three months, more than 70 000 births are
expected, of which 8500 will be born to adolescent mothers under 19 years old. There are 250 000 pregnant
and 170 000 breastfeeding women among the affected population and 122 obstetric complications are
expected daily.
1.b Assisting the Newly Disabled
An estimated 28 686 people were injured in
Typhoon Haiyan in addition to those already
living with a disability. In the aftermath of
the typhoon, WHO mapped all the service
providers for people with disabilities
across regions VI, VII and VIII. This
information was shared with the injured
people and the hospital staff where those
with more severe injuries were located.
WHO also encouraged the individuals to
make contact with providers then and or
on return to their home. WHO also shared
some individual details with NGOs active
in the affected areas so they could followup with people when they returned home.
There has been a real concern that in the areas affected by Typhoon Haiyan, people with disabilities faced
exclusion or received inadequate support. From January 26 to 31, 2014 focus group discussions were
conducted in Northern Cebu, Leyte, Iloilo, Capiz, Roxas and Antique to listen to the needs and
recommendations of people with disabilities. Using the information gathered, a report was published by
WHO and the National Council on Disability Affairs, which detailed the feedback from disabled people on
how to make the plans for the recovery of different sectors disability-inclusive.
WHO supported the development of a Guidance Note by the National Council on Disability Affairs to
promote elimination of discrimination against people with disabilities in the construction or repair of
buildings and other facilities for public use following Typhoon Haiyan. Its purpose was to provide guidance
on the design and construction of buildings and structures for public use by reminding all stakeholders of

the need to comply with the Accessibility Law of the Philippines. The Guidance Note also aimed to
promote additional considerations when constructing new shelters or repairing damaged houses of
people affected by Typhoon Haiyan. Detailed technical specifications were included in the amended
Implementing Rules and Regulations of the Accessibility Law that were attached to the guidance note.
While the note was developed for recovery and reconstruction post-Haiyan, it remains applicable for all
constructions and repairs in the future whether related to disasters or not.
1.c Tackling tuberculosis and Chronic Diseases
The displacement of populations and the loss of health care facilities and of medical services has made
the continued treatment of chronic diseases including hypertension, diabetes, cancer, heart ailments and
tuberculosis (TB) difficult. This is a serious issue as these diseases account for a large number of morbidity
and mortality in the region. While lack of treatment of most chronic diseases has localized impact on the
individual and their families, interruption of treatment for TB patients can create a higher risk of new
infections and of existing patients becoming resistant to TB medication. Therefore tackling TB became a
high priority for WHO in the immediate aftermath of the typhoon.
Many medical records were destroyed by the typhoon and local health staff had to compile a list of their
TB patients from memory so that follow up could take place. The DOH, WHO and health partners
established a system to locate persons with TB and to direct these individuals to their nearest treatment
center. TB treatment centers, including those for multi-drug resistant (MDR) TB and diagnostic
laboratories were mapped and assessed for functionality to enable the appropriate referral of patients or
TB suspects and reinstitution of therapy, diagnosis and facilities as soon as possible. The facility maps
were distributed in particular to foreign medical teams to assist them to make rapid referrals. WHO and
the DOH also quickly prepared and distributed a basic field manual to assist NGOs, foreign medical teams
and health centres in diagnosing and treating TB. The TB culture laboratory in Tacloban was completely
destroyed, but this was quickly repaired with the assistance of the Global Fund for AIDS, TB and Malaria.
Over a one month period, nearly 100 percent of the identified TB patients still remaining in the area were
back on treatment. There remains an ongoing concern that some people from villages along the coastline
migrated to other areas and the TB cases from all of these villages have not yet been traced. Therefore
work continues across the affected regions to ensure all patients are identified and put back on treatment.
Meanwhile the assessment of TB treatment and diagnosis facilities functionality continues along with
provision of further equipment and GeneXpert training for health care professionals.
1.d Mental Health and Psychosocial Support
In humanitarian emergencies such as natural disasters, the number of people with mental disorders is
estimated to increase by 6 to 11 %. Beyond mental disorders, people in emergency situations also often
experience psychosocial problems that cannot be quantified.
To adequately address the mental health and psychosocial needs of the population, the Department of
Health provided and coordinated initial psychosocial interventions through psychological first aid
throughout the affected areas. WHO worked with the DOH to introduce the use of psychological first aid
which differs from psychological debriefing when someone is encouraged to recall the details of a
potentially traumatic event by encouraging listening and then identification of those that need onward
referral towards more specialised services. Based on available evidence, experts now agree that
psychological first aid is more effective and less intrusive.
UN agencies, non-government organizations, academic institutions, faith-based groups, and individual
citizens also stepped in to respond to additional needs for mental health and psychosocial support and fill
gaps. WHO established and helped run mental health and psychosocial support groups at cluster level to
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address psychosocial needs. In order to keep track of who does what, where and when (4Ws), WHO has
started collating the 4Ws data weekly on mental health and psychosocial support where possible.
In December, WHO together with DOH held a workshop on "Public Mental Health in Humanitarian
Emergencies for Adults and Youth: The Role of Psychology" and produced a further document with
guidance for practitioners. WHO conducted a series of training of trainers on psychological first aid and
disseminated printed guidelines among representatives of the government, national professional
associations and key NGO networks. By March, there had been core and supplemental trainings on the
Mental Health Global Action Program (mhGAP) in Tacloban and Ormoc for primary health care doctors
and nurses. In Eastern Samar, the core training is ongoing. WHO has also supported work in Cebu to
provide expanded tertiary care including outpatient facilities and multidisciplinary training.
Psychological support has also been provided specifically for People Living with HIV/AIDs in the affected
communities. The Philippines has one of the fastest growing HIV/AIDS rates in the world. During the
immediate response, WHO and the DOH ensured that the people undergoing treatment were accounted
for by the treatment hubs in Regions VI, VII and VIII. The availability and condition of the antiretroviral
drugs were also verified. In response to the needs identified by the three DOH Regional Program
Coordinators and the respective treatment hubs, the WHO organised training for health care
professionals in Regions VI and VIII. Further assessments of the participants are planned at least one
month after training to ensure impact and work is ongoing to ensure that people living with HIV/AIDS are
supported during the recovery phase.
1.e Management of the Deceased
The Mayor of Tacloban and officials requested support from WHO for families and the local community to
identify and bury the deceased. The number of dead in and around the city of Tacloban was the greatest
of any area affected by the typhoon. In the immediate aftermath, bodies were buried in temporary mass
graves scattered across the city and surrounding areas and there were further bodies being discovered on
a daily basis in undergrowth or near water.
In November December 2013 WHO invited an international expert to develop best practice and
Standard Operating Procedures (SOPs) for DOH on dead body management and mass casualty
management including practice on the ground, registration and tracking. The Government of the
Philippines subsequently appointed the National Bureau of Investigations (NBI) to coordinate national and
local government agencies involved in dead body management including the exhumation, processing and
burial of bodies to enable identification for relatives. WHO also supported the location of unburied bodies
by helping make available a team of trained cadaver retrieval dogs and providing additional training to
local teams by international experts.
Tacloban City is the only city or municipality in the Typhoon affected area that has so far chosen to
exhume and process mass graves in order to support identification and return of bodies to loved ones so
as to address psychosocial concerns in the aftermath of the typhoon. WHO has been supporting this
process including the erection of the processing tents, the work of the processing facility and the
purchase of body bags. Today, the city of Tacloban has completed this work and the 2200 bodies
recovered are buried in individually marked plots. The next phase of this work is the genetic tracing of
relatives using the samples taken from the dead to match those of relatives who come forward to search
for their loved ones.
2. PREVENT: Strengthen the alert and surveillance capability to address public health threats and inform
provision of health care including immunization and outbreak response.

In the aftermath of the typhoon the lack of basic infrastructure, clean water and food supplies as well as
overcrowding in shelters and from migration created fertile grounds for the outbreak and spread of
infectious diseases.
In this context, WHO undertook activities in four key areas:
2.a Immunization
2.b Strengthening early warning disease surveillance systems and preparation of contingency
plans in case of outbreak.
2.c Promoting good hygiene.
2.d Health care waste management
Immunization at a glance

Progress in each of these areas is as presented below.

2.a Immunization
After Typhoon Haiyan there was serious concern at the possibility of
outbreaks of communicable diseases. measles and polio vaccination
campaigns were a key priority. On November 26, there was a mass
vaccination campaign for a target population of 30 000 children in
Tacloban- the city hit hardest by the typhoon- to vaccinate against
measles and polio. The campaign was led by the Government of the
Philippines with support from WHO, the United Nations Children's Fund
(UNICEF) and other partners. The children also received Vitamin A
supplements to help improve their immunity against infections. A
further vaccination campaign was carried out across regions VI, VII and
VIII.

108,783 children received

Measles vaccines

49,902 children received oral

Polio vaccine dose.

31,390 children under five years

old were given Vitamin A to
improve their nutritional status.

Over 2.2 million children received

Measles vaccines in Manila in
Jan-Feb 2014.

January to February 2014, an expanded catchup measles immunization campaign was

conducted targeting over 2.2 million children
aged six months to three years in response to
a measles outbreak in Manila. The focus was
children living in all the cities in the National
Capital Region (NCR), all provinces and cities
in Region IV A, and the provinces of Bulacan
and Pampanga in Region III. Movement of
large numbers of people between Manila and
the Typhoon Haiyan- affected areas helped
spread the disease across the country.
External monitors were deployed to monitor
the campaign implementation and to perform rapid coverage surveys in selected high-risk communities.
Monitors were composed of WHO WPRO staff, United States Centers for Disease Control and Prevention
staff and members of the STOP (Stop Transmission of Polio) Team. A national measles immunization
campaign is currently planned for September 2014.
Cold chain
Vaccinations require a consistent cold chain temperature. Rebuilding the cold chain infrastructure has
been a shared priority for the Philippines Government, UNICEF and WHO. There have been assessments
of the state of the cold chain and equipment distributed. In Bohol, the WHO distributed cold chain
equipment after the region was affected by an earthquake in October 2013 and then again by the
Typhoon Haiyan the following month. The equipment included generators, ice lined refrigerators and
9

freezers, cold boxes, vaccine carriers, icepacks, safety boxes and temperature monitoring devices. In
Roxas, a cold chain assessment was completed by WHO and UNICEF and 18 refrigerators were provided.
WHO is currently procuring cold chain equipment for regions VI, VII and VIII to fill in the gaps after UNICEF
cold chain procurement activities have been completed. A total of 60 icepack freezers, 300 vaccine
carriers and 88 cold boxes have been ordered. In collaboration with WHO and in coordination with DOH,
UNICEF completed a four day orientation training in Manila on the new cold chain equipment to
Expanded Program on Immunization and cold chain managers of six regions on March 14.
In an attempt to Build back Better when reinstating health infrastructure and to make the cold-chain
more resilient to consequences of calamitous events, such as lack of power and diesel, WHO is also
exploring alternative technologies including the use of solar energy. WHO delivered 16 solar powered
vaccine refrigerators to key points in Leyte within three weeks of the Typhoon to support vaccination
campaigns.
Rabies
WHO has been supporting the Rabies elimination in the Visayas which aims to prevent human rabies
through the control and elimination of dog rabies by 2015. Vaccination of dogs has been proven to be the
most cost effective method to eliminate rabies overall. Unfortunately the three priority regions for this
program were also those worst hit by the typhoon. In the aftermath, the WHO assessment of program
resources including dog vaccines, needles, syringes, vaccine carriers as well as dog catching equipment
revealed that all had been damaged or destroyed. The animal laboratory diagnostic support in Eastern
Visayas Region was also totally destroyed. There have been increasing reports of dog bites in the affected
three regions, especially in Tacloban and Ormoc. WHO has prepared a plan to assist the three regions and
is providing ongoing technical support. Investigations of reported deaths due to rabies are being
conducted with the DOH and Department of Agriculture. Procurement of essential equipment is
underway and improvements are being made in the diagnosis and treatment of bite victims.
2.b Strengthening early warning disease surveillance system
SPEED
WHO has been involved from the very beginning in
strengthening the Surveillance in Post Extreme
Emergencies and Disasters or SPEED. This is the Filipino
Early Warning Surveillance System that is activated in
post-disasters and extreme emergency situations and
was developed by DOH in collaboration with WHO after
the country was devastated by a series of tropical storms
in 2009. It was conceptualized to provide real time health
information reporting after a disaster. The objectives of
SPEED are the early detection of an increase in
communicable and non-communicable diseases; to
monitor trends of health conditions under surveillance;
and to enable identification of appropriate responses.
Resources can then be prioritized and channeled to ensure disease outbreaks are contained. It undertakes
syndromic surveillance of 21 health conditions; is activated within 24 hours post-disaster; and uses
information and communication technology (e.g. text messaging, internet) for data collection, analysis
and report generation.

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Post-typhoon Haiyan, the SPEED surveillance system was activated on November 10 and continued
reporting until March 81. By then systems were already being put in place to transition into the routine
surveillance systems of the Department, viz., PIDSR (Philippine Integrated Disease Surveillance and
Response System) and ESR (Event-based Surveillance and Response). Now WHO continues its work to
strengthen surveillance through PIDSR and ESR.
During the initial four months, when SPEED was in place, it was implemented in 411 health facilities2 in
the affected areas of Regions VI, VII, and VIII to permit the early detection of epidemic-prone diseases
and to minimize morbidity and mortality of the predetermined 21 syndromes. Of these, 145 were Rural
Health Units, 131 Barangay Health Stations, 63 hospitals, 38 mobile clinics, 20 evacuation centers, 12
foreign medical teams and 6 hospitals run by foreign medical teams.
Over 340 000 consultations were reported through SPEED in the affected areas and it generated
approximately 3000 alert signals. The majority of these were for acute watery diarrhea (58%),
suspected measles (13%), acute hemorrhagic fever (9%), acute bloody diarrhea (6%) and suspect
leptospirosis (5%). In addition, alerts were also generated for typhoid fever, dengue, rabies and
suspected meningococcemia.
Action was then undertaken in response to the alerts generated in order to prevent any likely outbreaks.
For instance, in the case of suspected measles, investigation and outbreak response immunization (ORI)
were conducted by local public health authorities, in accordance with the National guidelines for measles
ORIs in Capiz, Iloilo, Biliran, Eastern Samar and Leyte. In the case of acute watery diarrhea, investigations
were conducted and water, hygiene and sanitation activities were implemented in Aklan, Iloilo, Eastern
Samar and Leyte. Epidemiological and environmental investigations were conducted and outbreak
control measures were taken when a typhoid alert was raised in Cebu province. Vector control activities
were instituted and are still ongoing in Eastern Samar and Leyte in response to reporting of suspected
dengue cases. Three deaths were reported due to suspect rabies in Eastern Samar. Dog vaccination,
advocacy and community information campaigns are still ongoing. Two deaths for suspect
meningococcemia were reported in Leyte: an epidemiological investigation was conducted and
meningococcal chemoprophylaxis was given to people who were in contact with these cases.
WHO has supported trainings on SPEED for all districts and several municipalities outside of Ormoc city
and provided rapid diagnostic tests for Ormoc District Hospital and Ormoc City Health Office. WHO is
currently supporting the Center for Health
Examples of WHO Assessments and Follow-Up Action:
Development in the follow-up, monitoring and
Flood assessments in Roxas in January.
technical assistance of local health staff in the
Reassessment of the oil spill area in Estancia, also in
surveillance for communicable disease control in the
January.
different municipalities of Leyte and Eastern Samar.
Assessments on the Health Care Waste
Management Systems of 15 hospitals spread across
The monitoring visits conducted by WHO and Center
Regions VII and VIII.
for Health Development staff will identify problems
Entomological investigations in bunk houses in
and issues encountered by the health workers in the
Ormoc and Tacloban.
implementation of the surveillance system, PIDSR,
An acute watery diarrhoea preparedness and
and provide technical assistance in teaching and
response plan for region VIII was completed by the
Philippines Department of Health, WHO and UNICEF
coaching on data encoding and data analysis.
in February.

In addition to strengthening the surveillance being

undertaken through the health facilities, WHO has also been actively undertaking other assessments and
follow-up action including the drawing up of strategic plans to strengthen disease and outbreak control. A
summary of some examples of these are presented in the adjacent box.
1
2

Some medical facilities continued with speed reporting until March 31.
These facilities reported at least once through SPEED from 10 November 2013 to 8 March 2014.

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2.c Promoting good hygiene

The damage caused by Haiyan has forced some people to live in crowded conditions, with poor water and
sanitation, where the potential for outbreaks of communicable disease are much higher than usual. In
such situations the importance of promoting good hygiene practices, ensuring good water quality and
controlling vector populations, cannot be overemphasized. Mapping was done to identify areas most in
need of action and this information was used to direct initial fogging and clean-up activities.
WHO collaborated with the DOH in conducting water quality testing in Leyte and Eastern Samar between
November-December 2013. Findings revealed that 30-40% of the drinking water in these regions was
contaminated. Health promotion activities focused on hygiene issues were conducted with the affected
communities including explaining the correct use of chlorine disinfectants and water purification tablets.
WHO conducted a field assessment in January to discover local water quality monitoring and
management capacity in Local Government Units in Eastern Samar and Leyte, including Tacloban and
Ormoc. Findings showed not all Local Government Units had functional monitoring systems in place. In
partnership with DOH, WHO conducted a series of trainings for 140 sanitary inspectors on water quality
for LGUs in Region VI (Aklan, Antique, Capiz, Iloilo), VII (Bohol, Cebu) and VIII (Tacloban, Eastern Leyte). In
addition to the water quality training sessions, a large number of water quality testing kits have also been
distributed to priority areas.
Entomological investigations (mosquito studies) carried out by WHO in bunk houses in Ormoc and
Tacloban revealed that in all sites that were investigated, dengue and chikungunya vector (Aedes aegypti
and Aedes albopictus mosquitoes) breeding sites were present. Using this information, community
mobilization to encourage environmental clean-ups has been initiated in order to reduce the breeding
sites at household, community and institutional level. The involvement and participation of other
stakeholders including the Departments of Education, churches, and local government units has been
encouraged to help support activities to prevent and control dengue and chikungunya in the affected
areas. The Ormoc City Health Office, with support from WHO, has now finalized a training plan for Dengue
Vector Surveillance and Vector Control. WHO is developing a strategy across the typhoon-affected areas
to address the upcoming dengue season.
2.d Health Care Waste Management
WHO conducted assessments on the Health Care Waste Management Systems of 15 hospitals spread
across Regions VII and VIII. The data showed that out of the 1800 kg of healthcare waste generated daily,
47% contains medical waste that is disposed of in open waste dump sites; 69% of these health facilities
have no wastewater treatment plant nor wastewater treatment system; 52% of health facility staff have
never had training on health care waste management; 7% of the health facilities are using mercury
devices despite a DOH ban since 2009; 30% of health facilities do not practice segregation of waste at
source; 27% of health facilities have no Personal Protective Equipment (PPE), 47% have partial PPE, and
28% have complete PPE. A series of trainings on health care waste management have been conducted in
Leyte and Eastern Samar. Hygiene promotion was introduced as part of the training modules. WHO also
assisted in the consultation meeting with Local Government Units and hospitals on how to address health
care waste issues in the province of Leyte. Further training and equipment for health care waste
management is due to be provided in the coming months.
3. REBUILD Establish an equitable basic system of primary and secondary healthcare functions, and access
to a tertiary referral system in all areas (including management of victims of gender based violence)
without financial barriers to access for affected populations

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The DOH, in collaboration with WHO and other health partners, continues to provide the necessary
technical and material resources required to enable functional health facilities. Six months post-Typhoon
Haiyan, more than half of all pre-existing health facilities are now either partially or fully functional.
On behalf of DOH and the health cluster, in November and December 2013, WHO mapped the health facilities
that were functioning, damaged or destroyed as a result of the typhoon. Using this information WHO was able
to advise on the immediate deployment of medical equipment and foreign medical teams; and to identify
which health centres were a priority for repair and rebuilding to ensure adequate health care for the
community.
WHO continues to map the ongoing repair and rehabilitation of health facilities to help guide the recovery
effort. For example, in Tacloban, WHO is providing mapping support to identify all health facilities located
within unsafe areas, as all critical infrastructure in this area will have to be relocated according to a recent
bill passed by the Government of the Philippines.
On 21 January, the DOH and WHO convened a panel discussion in Manila on building back better
hospitals and other health facilities. Experts from the Philippines, Japan and WHO presented lessons
learnt and good practices on safe hospitals. WHO has identified and, has either supported or plans to
support, the improvement of health facilities including those listed in the annex where it is considered a
particularly important priority to ensure these facilities are up and running quickly to serve the
community.
DOH, with the support of WHO, is utilizing a unique and innovative approach to support the rehabilitation
and rebuilding of typhoon-affected Community Health Centers . Under the title Rising Anew - Health at
the Heart of Healing a photobook has been developed and will be disseminated to health partners and
the public in the coming weeks. The 92 page document presents 31 out of 96 damaged community health
centers, focusing on the most damaged in Region VIII and provides detailed information on the damages
and the estimated costs for repairs. Meanwhile maps on the latest state of repair and funding for
rebuilding continue to be available on the WHO Philippines website.
4. LINK: Strengthen the coordination and integration of health care with other services and
clusters
Maintaining inter-cluster coordination
In addition to the Health Cluster, the humanitarian response to the typhoon is being channelled through a
number of other clusters:
Food security and agriculture
Shelter
Early recovery/ livelihood
Water, Sanitation and Hygiene (WASH)
Education
Protection/ Gender Based Violence/ CP
Logistics
Nutrition
Coordination
Camp coordination and camp management (CCCM)
Clearly, a number of these clusters are cross-cutting, especially regarding the health sector. It is important
to coordinate with these different clusters to ensure that everyone is aware of who is doing what, where
and when and any duplication of work is avoided. This also ensures that different sector or cluster
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strategies support the objectives of one another, expertise is pooled to develop more holistic solutions,
and cross-sectoral cooperation is effective.
WHO has been actively taking the
initiative to maintain inter-cluster
coordination. In the aftermath of the
typhoon, WHO undertook a damage
assessment of major health facilities.
The damage assessment was done
collaboratively with DOH and OCHA.
WHO has also led the regular
production of the Health Cluster
reports to provide information that is
useful not just for members of the
Health Cluster but also for those
working particularly in the Shelter,
WASH, Protection and Nutrition
clusters. The same is true for the
health facility maps and other data
collected by WHO that is regularly
shared with other clusters.
WHO has provided support to other clusters where needed. For example, the Nutrition Cluster in Ormoc
asked WHO for support on the management of malnutrition in children with underlying neurological
conditions. A WHO expert has been put in contact with the local coordinator to provide technical
mentoring. As noted above, WHO supported the development of a Guidance Note by the National Council
on Disability Affairs to promote the elimination of discrimination against people with disabilities in all
sectors and provide guidance on the construction or repair of buildings and other facilities for public use
following Typhoon Haiyan.
Establishing and maintaining subnational Health Cluster hubs in 6 key locations.
The WHO established six Health Cluster hubs in addition to a national hub in Manila, in order to support the
DOH and coordinate the health response:
Tacloban on 11 November
Cebu on 13 November
Roxas on 17 November
Ormoc on 18 November
Borongan, Guiyan on 25 November
Palo, regional field office, early December
The hubs were designed to ensure operational reach and provide a logistical platform to plan, execute and
monitor the health recovery interventions by all partners. The national hub in Manila continues to
compliment sub-national hubs for typhoon response. At the request of the DOH the WHO will continue to
operate two field offices Palo for Region VIII and Cebu for Regions VI and VII (also covering the
earthquake affected areas in Bohol), as well as four hubs to cover affected areas in Region VIII (Tacloban
City/West Samar, Ormoc City/West Leyte, East Leyte hub based in Palo and Eastern Samar hub based in
Borongan). Dedicated WHO office space continues to be provided by DOH in Iloilo to assist with
coordination of support in Region VI and in Tagbilaron to assist with coordination of support in
earthquake affected areas of Bohol in Region VII.

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Looking Ahead: Key challenges

While much progress has been achieved in these six months since Haiyan, a lot remains to be done. The
delivery of critical services such as immunization, facility based deliveries, antiretroviral treatment, and TB
detection and treatment remains a challenge. Replacement of the rabies dog vaccines and equipment
that were destroyed by the typhoon is a priority to avoid further spread of the disease and help achieve
the national goal to eliminate rabies. A rise in birth rates and an increasing trend of pregnancy in teenage
girls who are also seeking prenatal care is of great concern and requires extra support. The exit of the
many foreign medical teams providing free healthcare in the region puts an increased burden of care on
the government health facilities.
The risk of flooding and strong winds threatens all temporary buildings including health facilities,
particularly those still operating out of tents. There are insufficient numbers of evacuation centers and
emergency accommodation available. Furthermore, some people have repaired their homes and offices
using materials that are unlikely to withstand even category 1 winds leading to an overall increased risk of
further injuries and fatalities.
The onset of the rainy season also threatens to increase the risk of seasonal vector borne diseases. This
threat needs to be tackled now through the preparation and timely implementation of vector control
plans, and the preparation of contingency plans in case of outbreaks. A further health risk is the continued
practice of open dumping of medical waste, and tackling this issue poses a major challenge in terms of
investment in training and the necessary equipment.
Finally, the security situation in parts of eastern and southern regions at times limits WHOs capacity to
fully and freely mobilize health support services where required.
Looking ahead and with a view to meeting the challenges outlined above, WHO will now move from
providing immediate emergency response, to longer term rebuild and rehabilitation activities. The
response will continue to be focused on the achievement of all four of the health objectives highlighted in
the Strategic Response Plan plus an added objective of preparing for the oncoming rainy season. These
five objectives are:
1.
2.
3.

4.

5.

TREAT: Address the immediate health needs of the affected especially for obstetric and neonatal
care, mental health and psychosocial support, and the care of the deceased and bereaved.
PREVENT: Strengthen the alert and surveillance capability to address public health threats and
inform the provision of health care including immunization and outbreak response.
REBUILD: Establish an equitable basic system of primary and secondary healthcare functions, and
access to a tertiary referral system in all areas without financial barriers to access for affected
populations.
LINK: Strengthen the coordination and integration of the health care with other services and
clusters including for protection issues around mental health and psychosocial support and gender
based violence.
PREPARE: Prepare for the oncoming rainy season and likely typhoons in the affected areas through
purchase and pre-positioning of contingency supplies; repair and rebuilding of all remaining health
facilities; and further strengthening health services.

WHO will continue its work to help the communities affected by Typhoon Haiyan to build back better
the health facilities and services they need. There are plans in place to address the different challenges
listed above and WHO remains very grateful for the ongoing support of its donors as the organization
continues to help improve the lives of some of the poorest and most vulnerable people in the Philippines.

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Annex: Health Facilities For Improvement

East Samar Facility
Balangkayan Rural Health Unit
Quinapondan Community Hospital
Balangiga, Albino Duran Hospital
Gigoso, Giporios Barangay Health Station
Asgad, Salcedo Barangay Health Station
East Leyte Facility
MacArthur Rural Health Unit
Ormoc/West Leyte Facility
San Isidor
Ormoc Health Centre complex
Kananga Municipal Hospital
6 birth centres in Ormoc
Tacloban Facility
Holy Cross Forensic Centre
Tacloban City Health Office and Rural Health
Unit
Tacloban City Hospital, Marasbaras Womens
Centre
Eastern Visayas Regional Medical Center
Cebu Facility
Vincente Sotto Memorial Medical Centre

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